Anemia

Question 1

At every visit a pt with anemia should be monitored for what?

Answer 1

Hemodynamic instability

Question 2

What are symptoms of hemodynamic instability?

Answer 2

DEC urine output (DEC urination)

Altered LOC or LOC

Question 3

What exams would you want to do to assess for hemodynamic instability? And what findings would alert you that the pt may not be hemodynamically stable?

Answer 3

Vitals: tachycardia/bradycardia, low O2 sat (high CO2 output), HTN/hypotension, wide pulse pressure

Heart: arrhythmias, distant/muffled heart sounds, JVD, pericardial effusion

Lungs: agonal resps, pulmonary edema, pleural effusion

GI: ascites

Extremities: DEC peripheral pulses, slow cap refill, peripheral edema

Skin: pallor, cyanosis (peripheral/central), coolness (extremities), anasarca

Question 4

If a pt who is not hemodynamically stable, what does HTN mean? What about hypotension?

Answer 4

HTN - compensated

Hypotension - progressive

Question 5

If you have a patient’s HGB level (Hx of anemia), what are the criteria for referral/hospitalization…

HGB <7 g/dL

Answer 5

REFER TO ER!

RBC transfusion indicated (if pt stable 2 units of packed RBCs, then continual HGB monitoring)

Question 6

If you have a patient’s HGB level (Hx of anemia), what are the criteria for referral/hospitalization…

HGB 7-10 g/dL

Answer 6

Unclear zone - clinical judgement and pt status.

Is pt hemodynamically stable? May not need transfusion or immediate hospital referral

Pt not hemodynamically stable? ER referral

Need to assess for location of acute bleed (r/o) and compare HGB with previous labs.

Question 7

If you have a patient’s HGB level (Hx of anemia), what are the criteria for referral/hospitalization…

HGB >10 g/dL

Answer 7

No RBC transfusion needed

Question 8

What patient’s are high risk and may need more immediate referral to ER or blood transfusion? What is the level of HGB would you transfuse these people?

Answer 8

> 65 yo
PMHx of Cardiovascular or Respiratory disease

HGB <8 g/dL

Question 9

When a patient presents with anemia or has a first-time diagnosis of anemia, what should be your first step?

Answer 9

ID the underlying cause because treatment guidelines will vary depending on cause of anemia.

Question 10

Blood transfusion should be reserved for who?

Answer 10

Pt hemodynamically unstable (orthostatic hypotension)
Unstable d/t active bleeding
And/or
Shows evidence for end-organ ischemia

Question 11

What does the data show regarding blood transfusion for patient’s who are anemic?

Answer 11

Beneficial: HGB <6 g/dL

Not helpful: HGB >10 g/dL